Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review

Reidar P Lystad, Gregory Bell, Martin Bonnevie-Svendsen, Catherine V Carter, Reidar P Lystad, Gregory Bell, Martin Bonnevie-Svendsen, Catherine V Carter

Abstract

Background: Manual therapy is an intervention commonly advocated in the management of dizziness of a suspected cervical origin. Vestibular rehabilitation exercises have been shown to be effective in the treatment of unilateral peripheral vestibular disorders, and have also been suggested in the literature as an adjunct in the treatment of cervicogenic dizziness. The purpose of this systematic review is to evaluate the evidence for manual therapy, in conjunction with or without vestibular rehabilitation, in the management of cervicogenic dizziness.

Methods: A comprehensive search was conducted in the databases Scopus, Mantis, CINHAL and the Cochrane Library for terms related to manual therapy, vestibular rehabilitation and cervicogenic dizziness. Included studies were assessed using the Maastricht-Amsterdam criteria.

Results: A total of fifteen articles reporting findings from thirteen unique investigations, including five randomised controlled trials and eight prospective, non-controlled cohort studies were included in this review. The methodological quality of the included studies was generally poor to moderate. All but one study reported improvement in dizziness following either unimodal or multimodal manual therapy interventions. Some studies reported improvements in postural stability, joint positioning, range of motion, muscle tenderness, neck pain and vertebrobasilar artery blood flow velocity.

Discussion: Although it has been argued that manual therapy combined with vestibular rehabilitation may be superior in the treatment of cervicogenic dizziness, there are currently no observational and experimental studies demonstrating such effects. A rationale for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is presented.

Conclusion: There is moderate evidence to support the use of manual therapy, in particular spinal mobilisation and manipulation, for cervicogenic dizziness. The evidence for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is lacking. Further research to elucidate potential synergistic effects of manual therapy and vestibular rehabilitation is strongly recommended.

Figures

Figure 1
Figure 1
PRISMA flow diagram.

References

    1. Sloane PD. Dizziness in primary care: Results from the National Ambulatory Medical Care Survey. Journal of Family Practice. 1989;29(1):33–38.
    1. Yardley L, Owen N, Nazareth I, Luxon L. Prevalence and presentation of dizziness in a general practice community sample of working age people. British Journal of General Practice. 1998;48(429):1131–1135.
    1. Johansson M, Andersson G. Prevalence of dizziness in relation to psychological factors and general health in older adults. Audiological Medicine. 2006;4(3):144–150. doi: 10.1080/16513860600997483.
    1. Stevens KN, Lang IA, Guralnik JM, Melzer D. Epidemiology of balance and dizziness in a national population: findings from the English Longitudinal Study of Ageing. Age and Ageing. 2008;37(3):300–305. doi: 10.1093/ageing/afn019.
    1. Neuhauser HK. Epidemiology of dizziness and vertigo. Der Nervenarzt. 2009;80(8):887–894. doi: 10.1007/s00115-009-2738-9.
    1. Drachman D, Hart C. An approach to the dizzy patient. Neurology. 1972;22(4):323–334.
    1. Froehling D, Silverstein M, Mohr D, Beatty C. Does this dizzy patient have a serious form of vertigo. Journal of American Medical Association. 1994;271(5):385–388. doi: 10.1001/jama.271.5.385.
    1. Enloe LJ, Shields RK. Evaluation of health-related quality of life in individuals with vestibular disease using disease-specific and general outcome measures. Physical Therapy. 1994;77(9):890–903.
    1. Ardç FN, Topuz B, Kara CO. Impact of multiple etiology on dizziness handicap. Otology and Neurotology. 2006;27(5):676–680. doi: 10.1097/01.mao.0000226292.49789.c9.
    1. Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy. 2000;30(12):755–766.
    1. Ryan G, Cope S. Cervical vertigo. Lancet. 1955;31:1355–1358.
    1. Lafon H. Les vertiges d'origine proprioceptive par lesion mecanique vertebrocervicale. Journal Francais d'Oto-Rhino-Laryngologie. 1990;39(5):269–278.
    1. Fitz-Ritson D. Assessment of cervicogenic vertigo. Journal of Manipulative and Physiological Therapeutics. 1991;14(3):193–198.
    1. Tjell C, Rosenhall U. Smooth pursuit neck torsion test: A specific test for cervical dizziness. American Journal of Otology. 1998;19(1):76–81.
    1. Abrahams VC. The physiology of neck muscles; their role in head movement and maintenance of posture. Canadian Journal of Physiology and Pharmacology. 1977;55(3):332–338. doi: 10.1139/y77-047.
    1. Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurology India. 2001;49(4):355–359.
    1. Boyd-Clark LC, Briggs CA, Galea MP. Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine. 2002;27(7):694–701. doi: 10.1097/00007632-200204010-00005.
    1. Liu J-X, Thornell L-E, Pedrosa-Domellöf F. Muscle spindles in the deep muscles of the human neck: A morphological and immunocytochemical study. Journal of Histochemistry and Cytochemistry. 2003;51(2):175–186. doi: 10.1177/002215540305100206.
    1. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy. 2008;13(1):2–11. doi: 10.1016/j.math.2007.06.003.
    1. Karnath H-O. Subjective body orientation in neglect and the interactive contribution of neck muscle proprioception and vestibular stimulation. Brain. 1994;117(5):1001–1012. doi: 10.1093/brain/117.5.1001.
    1. Cohen LA. Role of eye and neck proprioceptive mechanisms in body orientation and motor coordination. Journal of Neurophysiology. 1961;24:1–11.
    1. Biemond A, de Jong JMBV. On cervical nystagmus and related disorders. Brain. 1969;92(2):437–458. doi: 10.1093/brain/92.2.437.
    1. de Jong PTVM, de Jong JMBV, Cohen B, Jongkees LBW. Ataxia and nystagmus induced by injection of local anesthetics in the neck. Annals of Neurology. 1977;1(3):240–246. doi: 10.1002/ana.410010307.
    1. Wapner S, Werner H, Chandler KA. Experiments on the sensory-tonic field theory of perception: 1. Effect of extraneous stimulation of the visual perception of verticality. Journal of Experimental Psychology. 1951;42(5):351–357.
    1. Brandt T, Bronstein AM. Cervical vertigo. Journal of Neurology Neurosurgery and Psychiatry. 2001;71(1):8–12. doi: 10.1136/jnnp.71.1.8.
    1. Karlberg M, Magnusson M, Malmström E-M, Melander A, Moritz U. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Archives of Physical Medicine and Rehabilitation. 1996;77(9):874–882. doi: 10.1016/S0003-9993(96)90273-7.
    1. Galm R, Rittmeister M, Schmitt E. Vertigo in patients with cervical spine dysfunction. European Spine Journal. 1998;7(1):55–58. doi: 10.1007/s005860050028.
    1. Zhou W, Jiang W, Li X, Zhang Y, Wu Z. Clinical study on manipulative treatment of derangement of the atlantoaxial joint. Journal of Traditional Chinese Medicine. 1999;19(4):273–278.
    1. Reid SA, Rivett DA. Manual therapy treatment of cervicogenic dizziness: A systematic review. Manual Therapy. 2005;10(1):4–13. doi: 10.1016/j.math.2004.03.006.
    1. Sjölander P, Michaelson P, Jaric S, Djupsjöbacka M. Sensorimotor disturbances in chronic neck pain-Range of motion, peak velocity, smoothness of movement, and repositioning acuity. Manual Therapy. 2008;13(2):122–131. doi: 10.1016/j.math.2006.10.002.
    1. Denham T, Wolf A. Vestibular rehabilitation. Rehabilitation Management. 1997;10(3):93–94, 144.
    1. Hansson EE. Vestibular rehabilitation - For whom and how? A systematic review. Advances in Physiotherapy. 2007;9(3):106–116. doi: 10.1080/14038190701526564.
    1. Gans RE. Vestibular rehabilitation: Critical decision analysis. Seminars in Hearing. 2002;23(2):149–159. doi: 10.1055/s-2002-33000.
    1. Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews. 2011. p. art. no. CD005397.
    1. Hansson EE, Månsson N-O, Ringsberg KAM, Håkansson A. Dizziness among patients with whiplash-associated disorder: A randomized controlled trial. Journal of Rehabilitation Medicine. 2006;38(6):387–390. doi: 10.1080/16501970600768992.
    1. Collins ME, Misukanis TM. Chiropractic management of a patient with post traumatic vertigo of complex origin. Journal of Chiropractic Medicine. 2005;4(1):32–38. doi: 10.1016/S0899-3467(07)60110-4.
    1. Schenk R, Coons LB, Bennett SE, Huijbregts PA. Cervicogenic dizziness: A case report illustrating orthopaedic manual and vestibular physical therapy comanagement. The Journal of Manual & Manipulative Therapy. 2006;14(3):56–68.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine. 2009;151(4):264–269.
    1. Denham T, McKinnon WA. Vestibular Rehabilitation. Rehabilitation Management. 1997;10(144):93–94.
    1. van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for spinal disorders. Spine. 1997;22(20):2323–2330. doi: 10.1097/00007632-199710150-00001.
    1. Olmos M, Antelo M, Vazquez H, Smecuol E, Maurino E, Bai JC. Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease. Digestive and Liver Disease. 2008;40(1):46–53. doi: 10.1016/j.dld.2007.09.006.
    1. Lystad RP, Pollard H, Graham PL. Epidemiology of injuries in competition taekwondo: A meta-analysis of observational studies. Journal of Science and Medicine in Sport. 2009;12(6):614–621. doi: 10.1016/j.jsams.2008.09.013.
    1. Swain MS, Lystad RP, Pollard H, Bonello R. Incidence and severity of neck injury in Rugby Union: A systematic review. Journal of Science and Medicine in Sport. 2011;14(5):383–389. doi: 10.1016/j.jsams.2010.10.460.
    1. Becker VF. Dizziness complaints from the viewpoint of manual therapy. Manuelle Medizin. 1978;16(5):95–104.
    1. Biesinger E. Diagnosis and therapy of vertebrogenic vertigo. Laryngologie, Rhinologie, Otologie. 1987;66(1):32–36. doi: 10.1055/s-2007-998593.
    1. Borg-Stein J, Rauch SD, Krabak B. Evaluation and management of cervicogenic dizziness. Critical Reviews in Physical and Rehabilitation Medicine. 2001;13(4):255–264.
    1. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy. 2010;18:3. doi: 10.1186/1746-1340-18-3.
    1. Eber AM. Reeducation of patients with vertigo. La Revue du Praticien. 1994;44(3):367–71.
    1. El-Kahky AM, Kingma H, Dolmans M, de Jong I. Balance control near the limit of stability in various sensory conditions in healthy subjects and patients suffering from vertigo or balance disorders: impact of sensory input on balance control. Acta Oto-Laryngologica. 2000;120(4):508–516. doi: 10.1080/000164800750046018.
    1. Falkenau HA. The pathogenesis and management of cervical vertigo. HNO. 1976;24(10):339–341.
    1. Garcia FV. Disequilibrium and its management in elderly patients. International Tinnitus Journal. 2009;15(1):83–90.
    1. Grgic V. Cervicogenic proprioceptive vertigo: ethiopathogenesis, clinical manifestations, diagnosis and therapy with special emphasis on manual therapy. Lijecnicki Vjesnik. 2006;128(9-10):288–295.
    1. Grod JP. Effect of neck pain on verticality perception: a cohort study. Archives of Physical Medicine and Rehabilitation. 2002;83(3):412–415. doi: 10.1053/apmr.2002.29660.
    1. Hansson EE, Håkansson A. Physical therapy of vertigo. Lakartidningen. 2009;106(35):2147–2149.
    1. Hansson EE, Månsson N-O, Håkansson A. Balance performance and self-perceived handicap among dizzy patients in primary health care. Scandinavian Journal of Primary Health Care. 2005;23(4):215–220. doi: 10.1080/02813430500287299.
    1. Hawk C, Cambron J. Chiropractic care for older adults: effects on balance, dizziness, and chronic pain. Journal of Manipulative and Physiological Therapeutics. 2009;32(6):431–437. doi: 10.1016/j.jmpt.2009.06.009.
    1. Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW. Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. The Journal of Alternative and Complementary Medicine. 2007;13(5):491–512. doi: 10.1089/acm.2007.7088.
    1. Heikkilä H, Johansson M, Wenngren B-I. Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study. Manual Therapy. 2000;5(3):151–157. doi: 10.1054/math.2000.0357.
    1. Jäger S. Cervical vertigo in manual therapy. Zeitschrift für Physiotherapeuten. 2004;56(8):1398–1411.
    1. Jepsen O. Vertigo corrected from the cervical spine. Nordisk Medicin. 1963;69(23):675–676.
    1. Karlberg M, Persson L, Magnusson M. Impaired postural control in patients with cervico-brachial pain. Acta Oto-Laryngologica Supplementum. 1995;520:440–442.
    1. Maffei G. Vertigo in the pathology of the cervical spine. Acta Bio-Medica de l'Ateno Parmense. 1983;54(Supplement 1):21–26. no. 1.
    1. Persson L, Karlberg M, Magnusson M. Effects of different treatments on postural performance in patients with cervical root compression: a randomized prospective study assessing the importance of the neck in postural control. Journal of Vestibular Research. 1996;6(6):439–453.
    1. Rapaccini A, Pascucci W. Rehabilitative therapy of tinnitus and vertigo. Recenti Progressi in Medicina. 2003;94(7-8):323.
    1. Rohmer F, Collard M. Vertigo of cervical origin. La Revue du Praticien. 1974;24(1):95–107.
    1. Rong G. General rehabilitation of the cervical syndrome in 500 cases. Chinese Journal of Clinical Rehabilitation. 2003;7(6):1036.
    1. Scherer H. Neck-induced vertigo. Archives of Oto-Rhino-Laryngology Supplement. 1985;2:107–124.
    1. Seifert K. Peripheral vestibular vertigo and functional disorders of the craniovertebral joint. HNO. 1987;35(9):363–371.
    1. Takizawa H, Graille R, Dumolard P, Gignoux B. Vertigo and the cervical column. Le Journal de Medecine de Lyon. 1967;48(131):1639–1654.
    1. Teixeira LJ, Prado GF. Impact of physical therapy in vertigo treatment. Revista Neurociencias. 2009;17(2):112–118. doi: 10.4181/RNC.2009.17.112.
    1. Thomas D. Dizziness in osteopathic practice. Osteopathische Medizin. 2009;10(2):29–31.
    1. Yardley L, Beech S, Zander L, Evans T, Weinman J. A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. British Journal of General Practice. 1998;48(429):1136–1140.
    1. Malmström E-M, Karlberg M, Melander A, Magnusson M, Moritz U. Cervicogenic dizziness - musculoskeletal findings before and after treatment and long-term outcome. Disability and Rehabilitation. 2007;29(15):1193–1205. doi: 10.1080/09638280600948383.
    1. Wu J-R, Fang M, Hu J, Shen G-Q, Jiang S-Y. Effects of manipulation on head repositioning skill in patients with cervical vertigo. Journal of Chinese Integrative Medicine. 2006;4(1):76–78. doi: 10.3736/jcim20060120.
    1. Wu J, Fang M, Hu J, Shen G, Jiang S. Action of tuina on retro-positioning of skull spatial offset in patients with cervical vertigo. Journal of Acupuncture and Tuina Science. 2008;6(2):83–86. doi: 10.1007/s11726-008-0083-3.
    1. Reid SA, Rivett DA, Katekar MG, Callister R. Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Manual Therapy. 2008;13(4):357–366. doi: 10.1016/j.math.2007.03.006.
    1. Kang F, Wang Q-C, Ye Y-G. A randomized controlled trial of rotatory reduction manipulation and acupoint massage in the treatment of younger cervical vertigo. Chinese Journal of Orthopedics & Trauma. 2008;21(4):270–272.
    1. Fang J. Observation of curative effect on fixed-point spin reduction of spinal manipulation therapy for cervical vertigo. Chinese Journal of Orthopedics & Trauma. 2010;23(2):99–101.
    1. Du H, Wei H, Huang M-Z, Jiang Z, Ye S-L, Song H-Q, Yu J-W, Ning X-T. Randomized controlled trial on manipulation for the treatment of cervical vertigo of high flow velocity type. Chinese Journal of Orthopedics & Trauma. 2010;23(3):212–215.
    1. Konrad K, Gerencser F. Manual treatment in patients with vertigo. Manuelle Medizin. 1990;28(4):62–64.
    1. Mahlstedt K, Westhofen M, König K. Therapy of functional disorders of the craniovertebral joints in vestibular diseases. Laryngorhinootologie. 1992;71(5):246–250. doi: 10.1055/s-2007-997289.
    1. Uhlemann C, Gramowski K-H, Endres U, Callies R. Manual diagnosis and therapy in cervical giddiness. Manuelle Medizin. 1993;31(4):77–81.
    1. Bracher ESB, Almeida CIR, Almeida RR, Duprat AC, Bracher CBB. A combined approach for the treatment of cervical vertigo. Journal of Manipulative and Physiological Therapeutics. 2000;23(2):96–100. doi: 10.1016/S0161-4754(00)90074-5.
    1. Hülse M, Hölzl M. Vestibulospinal reflexes in patients with cervical disequilibrium. Cervicogenic imbalance. HNO. 2000;48(4):295–301. doi: 10.1007/s001060050569.
    1. Chen I, Zhan H-S. A transcranial Doppler ultrasonography and X-ray study of cervical vertigo patients treated by manipulation in supine position. Journal of Chinese Integrative Medicine. 2003;1(4):262–264. doi: 10.3736/jcim20030409.
    1. Strunk RG, Hawk C. Effects of chiropractic care on dizziness, neck pain, and balance: a single-group, preexperimental, feasibility study. Journal of Chiropractic Medicine. 2009;8:156–164. doi: 10.1016/j.jcm.2009.08.002.
    1. Pickar JG. Neurophysiological effects of spinal manipulation. Spine Journal. 2002;2(5):357–371. doi: 10.1016/S1529-9430(02)00400-X.
    1. Schmid A, Brunner F, Wright A, Bachmann LM. Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilisation. Manual Therapy. 2008;13(5):387–396. doi: 10.1016/j.math.2007.12.007.
    1. Kristjansson E, Treleaven J. Sensorimotor function and dizziness in neck pain: implications for assessment and management. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(5):364–377.
    1. Schenk R, Coons LB, Bennett SE, Huijbregts PA. Cervicogenic dizziness: A case report illustrating manual and vestibular physical therapy comanagement. The Journal of Manual & Manipulative Therapy. 2006;14(3):E56–E68.
    1. Cooksey FS. Rehabilitation in vestibular injuries. Proceedings of the Royal Society of Medicine. 1946;39(5):273–278.
    1. Manzoni D. The cerebellum may implement the appropriate coupling of sensory inputs and motor responses: Evidence from vestibular physiology. The Cerebellum. 2005;4:178–188. doi: 10.1080/14734220500193493.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever